[Recombinant proteins or monoclonal antibodies: comparative properties and interest in systemic lupus erythematosus]

The emergence of biologic therapies, such as monoclonal antibodies or recombinant fusion proteins, have revolutionized the management of autoimmune disorders, in particular rheumatoid arthritis. These biologic agents have been engineered to deplete key cellular populations or to block cytokines or molecules involved in the activation and/or the differentiation of immune cells, such as T cells or B cells. In systemic lupus erythematosus (SLE), a monoclonal antibody directed against the B-cell activating factor of the TNF family (BAFF or BLyS), belimumab, has demonstrated its efficacy in large, randomized and placebo-controlled studies, whereas rituximab, a monoclonal antibody directed against the CD20 expressed by B cells, failed to achieve his primary endpoint in renal and non-renal SLE. Studies on the safety and the efficacy of monoclonal antibodies or recombinant fusion proteins directed against other key molecules involved in the pathogenesis of SLE are ongoing.